胫骨结节解剖标志在胫骨髓内钉进针点选择的应用研究

发布时间：2018-06-18 01:59

本文选题：胫骨干骨折 + 髓内钉　；参考：《延安大学》2017年硕士论文

【摘要】：目的:通过对门诊患者和自愿者拍摄双小腿标准全长正侧位X线片,在X线片上测量胫骨结节最高点至胫骨轴线间的垂直距离,确定国人最佳胫骨髓内钉进针点在冠状位与胫骨结节最高点的关系,试图寻求一种简单准确的确定正确进针点的方法,为胫骨干骨折行髓内钉内固定术髓内钉进针点的选择提供参考依据。方法:对2015年11月至2016年10月前来延安大学附属医院创伤骨科门诊就诊的患者和志愿者共40位拍摄双小腿标准正侧位全长(包踝关节、膝关节)X线片。拍摄X线时,膝关节尽量伸直,下肢处于中立位,髌骨垂直向上,在胫骨结节最高点处皮肤上作出标记,放置直径为3mm金属小球。拍摄X线后,把金属小球在X线片上显影小圆点的圆心作为胫骨结节在X线上的投影,在X线片上画出胫骨轴线。测量胫骨结节最高点至胫骨轴线的垂直距离,计算其95%置信区间。再将80个下肢分别按性别、左右侧进行分组,对其测量结果进行比较,采用两独立样本t检验。结果:1.80例下肢的胫骨结节体表投影74个位于胫骨轴线的外侧,6例位于胫骨轴线的内侧,男4例,右腿2例,左腿2例;女2例,右腿1例,左腿1例;胫骨结节与胫骨轴线的垂直距离为(3.27±0.32)mm,95%置信区间为(3.20mm,3.34mm)。2.按性别分组,对测量结果进行比较时,男性组胫骨结节与胫骨轴线的垂直距离为:(3.28±0.32)mm;女性组胫骨结节与胫骨轴线的垂直距离为:(3.27±0.32)mm。男女两组数据进行比较时:差异无统计学意义,(P=0.8610.05)。3.当以左右侧肢体不同对80例下肢进行分组,对测量结果进行比较时,左侧组胫骨结节与胫骨轴线的垂直距离为:(3.26±0.28)mm;右侧组胫骨结节与胫骨轴线的垂直距离为:(3.32±0.35)mm。左右侧两组数据进行比较时:差异无统计学意义,(P=0.3940.05)。结论:胫骨结节在胫骨近端的解剖标志中最容易确认,通过胫骨结节解剖标志确定胫骨髓内钉进针点,操作简单可靠。通过实验研究确定胫骨轴线位于胫骨结节内侧或外侧(3.27±0.32)mm处,该位置也是髓内钉最佳进针点,内侧居多,其中性别、左右侧下肢对研究结果无明显影响。相比较国外研究胫骨轴线在冠状面位于胫骨结节偏内0.5-1.0cm处,国人胫骨轴线在冠状面更靠近胫骨结节中点。
[Abstract]:Objective: to measure the vertical distance from the highest point of tibial tubercle to the axis of tibia by taking the standard full-length radiographs of both legs from outpatient patients and volunteers, and to measure the vertical distance between the highest point of tibial nodule and the axis of tibia on X-ray film. To determine the relationship between the best tibial intramedullary pin point and the highest point of tibial nodule in Chinese, we try to find a simple and accurate method to determine the correct point of insertion. To provide a reference for the selection of intramedullary nail insertion point for tibial shaft fracture with intramedullary nail fixation. Methods: from November 2015 to October 2016, 40 patients and volunteers who came to the Department of Orthopaedics, affiliated Hospital of Yan'an University to visit the Department of Trauma and Orthopedic Department from November, 2015 to October, 2016, were selected to photograph the full length of the standard anteroposterior and lateral leg (including ankle joint and knee joint). The knee joint was as straight as possible, the lower limb was in neutral position, the patella was vertical upward, the skin was marked at the highest point of the tibial tubercle, and the diameter of the metal ball was 3mm. After the X-ray film, the center of the metal ball on the X-ray film was used as the projection of the tibial nodule on the X ray, and the axis of the tibia was drawn on the X ray film. The vertical distance from the highest point of the tibial nodule to the tibial axis was measured and its 95% confidence interval was calculated. Then 80 lower limbs were divided according to sex, left and right side, the results were compared and two independent samples t test were used. Results 74 cases were located on the medial side of the tibial axis, including male 4 cases, right leg 2 cases, left leg 2 cases, female 2 cases, right leg 1 case, left leg 1 case. The vertical distance between tibial nodule and tibial axis is 3.27 卤0.32 mm / 95% confidence interval is 3.20 mm / 3.34 mm 路2. The vertical distance between tibial nodule and tibial axis in male group was 3.28 卤0.32 mm, and that in female group was 3.27 卤0.32 mmm. When comparing the two groups of data: the difference was not statistically significant (P < 0. 8610.05). The vertical distance between the tibial nodule and the tibial axis in the left group was 3.26 卤0.28 mm, and the vertical distance between the right tibial nodule and the tibial axis was 3.32 卤0.35 mmm. The difference between the two groups was not statistically significant (P = 0.3940.05). Conclusion: tibial nodule is the most easily identified anatomic marker in proximal tibia. It is simple and reliable to determine the insertion point of tibial intramedullary nail by tibial nodule anatomic marker. The tibial axis is located at the medial or lateral part of the tubercle of the tibia (3.27 卤0.32)mm). This position is also the best entry point for the intramedullary nail. The medial point is the most common. Sex and lower extremity of the left and right side have no significant effect on the results. The tibial axis is located on the coronal plane at the inner 0.5-1.0cm of the tibial tubercle, and the Chinese tibial axis is closer to the middle point of the tibial tubercle in the coronal plane.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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